Provider Demographics
NPI:1629353610
Name:COLEMAN, DANIELLE HOUSTON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:HOUSTON
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 PARK RD
Mailing Address - Street 2:220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3238
Mailing Address - Country:US
Mailing Address - Phone:980-230-2144
Mailing Address - Fax:704-766-0211
Practice Address - Street 1:4600 PARK RD
Practice Address - Street 2:220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3238
Practice Address - Country:US
Practice Address - Phone:980-230-2144
Practice Address - Fax:704-766-0211
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical